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nctional preservation. Our nerve-sparing technique can reproducibly simplify this complex procedure.Study objective Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" in one session if desired (1-3). Pain and inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in the office setting (4-7). Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with history of cervical procedures such as cone biopsy.(8) It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than when facing the obliteration of the internal os. The aim of this video article, is to illustrate the use of simple techniques allowing to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in office hysteroscopy in patients with severe cervical stenosis including compe location of the external cervical os is determined. In cases where the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper or scissors. Recognition of landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates using the correct plane of dissection that leads into the uterine cavity. Additional maneuvers useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. Conclusion The combination of a delicate technique and operator experience will allow to overcome the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures decreasing the need to take patients to the OR and the use of general anesthesia.Background Telehealth use has been increasing over the last decade. Studies have shown that patients have a positive attitude towards incorporating telehealth into their healthcare. Significant uncertainty remains over reimbursement policies that vary widely between states and by payer. Objective Explore the clinical, operational, and financial feasibility of a home telehealth (HTH) program in a pediatric Allergy & Immunology (A&I) clinic. Methods A&I Physicians defined use cases they deemed appropriate for HTH appointments. Established patients in the A&I clinic were approached to complete an attitudes and perception survey. Patients meeting the use case definitions were asked to participate in the pilot program. After their HTH appointment took place, they completed a validated satisfaction survey. Our institution's revenue cycle management team provided reimbursement data. Results Patient attitudes toward HTH were generally favorable. 51 HTH appointments were offered and 46 appointments were made. 37 appointments were completed successfully among 32 unique patients. Patients were very satisfied with the HTH experience. 36 out of 37 encounters were reimbursed by 19 different public and private payers. Payers on average reimbursed ±6% of the expected allowable for an equivalent in-person visit. Conclusion Patients showed reservations about HTH initially but were very satisfied with their experience. Both private and public payers reimbursed HTH the same as in-person appointments. HTH is both well accepted by patients and financially viable.Background In children less then 2 years old, studies evaluating the value of skin prick tests (SPT) and specific immunoglobulin E (sIgE) results to predict persistence or resolution of egg allergy (EA) are limited. Additionally, the value of egg yolk (EY) sIgE and fresh egg (FE) SPT has not been well characterized. Objective We investigated the optimal decision points for outgrowing (ODP fo ) allergy with both SPT and sIgE tests for egg allergen preparations. Methods SPTs for FE, egg white (EW), EY, sIgEs for EW and EY and oral food challenges (OFC) were performed in children with suspected EA. Reactive patients strictly avoided all dietary egg. After one year, EA was re-evaluated with repeat OFC, SPTs, and sIgEs. Results Eighty-one children, median age 7 months (range 2-24 months) were enrolled. Four children with a history of anaphylaxis and 60/77 children with a positive challenge underwent egg elimination. The 1 year follow-up challenge test was performed on 59 children. Twenty-seven reacted to egg. No persistent patient had a follow-up SPT for FE ≤4mm (p less then 0.001; 100% PPV, 56% NPV for outgrowth). The diameters of the initial SPT for FE decreased 50% or more in half of the patients who outgrew EA. The ODP fo for follow-up sIgE for EY and EW were ≤2.1 kU/L (86.2% PPV) and ≤4.0 kU/L (84.6% PPV), respectively. Conclusion A diameter of SPT for FE ≤4mm and sIgE values of ≤2.1 kU/L for EY and ≤4.0 kU/L for EW have good PPV for outgrowth of EA under two years of age.Objective This in vitro study evaluated the caries status of the smooth surface surfaces in the primary molars using DIAGNOdent pen, Vistacam iX, and Bitewing radiography compared to the histologic assessments. Methods 68 primary molars were selected, and their mesial or distal caries status were determined using DIAGNOdent pen, Bitewing radiography, and Vistacam iX. selleck chemicals To achieve reference standards, the teeth were sectioned and directly assessed by a stereomicroscope. The Mc Nemar test was used to compare the sensitivity, specificity, and accuracy of the methods. The spearman rank correlation coefficient (r) was also determined to compare the extent of caries with histology. The statistical significance level was set at α = 0.05. Results Regarding D1 as a cut-off point for histological assessments, sensitivity, specificity, and accuracy of DIAGNOdent pen were 82%, 75%, and 80% while the values were 63%, 100% and 62% for bitewing radiography and 56%, 100% and 59% for Vistacam iX. Regarding D3 as a cut-off point for histological analysis; Sensitivity, specificity, and accuracy rates of DIAGNOdent pen were 71%, 86% and 80% while these values were 71%, 73% and 72% for bitewing radiography and 50%, 78% and 67% for Vistacam iX.